1. Field of the Invention
My invention relates to surgery and is an instrument for bringing the edges of the surgically split sternum into coaptation; it is a device designed to hold and drive a needle having a coaxial suture through the sternum; specifically, a needle holder.
2. Description of the Prior Art
It is reasonable to believe that in the ancient art of leather-working or similar craft, there was a pliers-type device having a first jaw adapted to support a needle and a second jaw adapted to cooperate with the first jaw, to support the workpiece against the force of the needle, letting the needle penetrate the workpiece and being forked to allow the needle point to extend beyond the second jaw. As a species of the above generic invention, my invention is a needle driver adapted for driving needles of a special type used in contemporary surgery, the needle having the suture fixed within a coaxial aperture in the base of the needle, as distinguished from the obsolescent type having a suture threaded through an eye in the needle. My search of the prior art uncovered no disclosure directed to driving needles having coaxial sutures, but the following U.S. Patents disclose other species of the above generic invention:
U.s. pat. No. 1,037,864 9/1912 Carlson et al PA1 U.s. pat. No. 1,464,832 8/1923 Richardson PA1 U.s. pat. No. 3,349,772 12/1967 Rygg
The inventions of both Richardson and Rygg are aimed at providing the needle, supported in a lower jaw with an enclosure over an appreciable part of its length, to support the needle against bending, employing spring means to effect retraction of the supporting enclosure during closure of the forceps on the tissue, to allow the needle to penetrate a greater length. The invention of Carlson et al is aimed at means for engaging and receiving the point of the needle in the upper jaw after the needle passes through the tissue, to aid in completing the stitch. While each of the references discloses a pliers-type device and each has a socket for holding the needle, they are all distinguisable from my invention because they are not adapted for driving needles having coaxial sutures, for which my invention is intended: the socket-channel-kerf means disclosed here are unique to my invention.
While adaptable to other procedures, my needle driver is specifically aimed at facilitating thoracic surgery of the type in which entrance is made by midline incision and midline splitting of the sternum, to afford access to the chest cavity by lateral retraction of the two sides of the rib cage. This procedure has become commonplace in recent times, following the successful introduction of the heart-lung machine and the popularization of surgical techniques for correction of septal, valvular, and vascular defects of the heart. Closing the surgical opening after completion of such procedures, the two sides of the split sternum must be reunited by mechanical means. The usual procedure is to employ a series of eight individual sutures placed at right angles to the incision and parallel with each other. Each stitch is made by a separate suture and each suture has a needle fixed coaxially at each end, the needles being inserted from the internal surface of the sternum to its anterior surface. All of the sutures are loosely placed until completion of the last stitch, when each pair of free ends of each suture is drawn together, bringing the two edges of the split sternum together in coaptation. The two free ends of each suture are drawn taught and joined together by surgical knot, or in the case of metal sutures, by other procedures such as twisting together, the excess being snipped off.
The sternum consists of tough bony surfaces of variable thickness with a space in between filled with osseous trabeculae, the interstitial space being filled with marrow-like tissue having blood forming function. In thickness, it is not unusual to find in the human male a sternum thickness of as little as one-eighth or as great as one half-inch. The toughness of the sternum is therefore subject to considerable variability.
In some cases, it is no problem to insert the sutures through the sternum using conventional needle forceps but in the majority of cases it is a difficult job and in some cases it is not possible to do so with conventional means and an alternative technique must be employed. One such alternative is to encircle the body of the sternum with the sutures, passing the sutures through the intercostal spaces just lateral to the sternum. This procedure is believed to be inferior because it does not afford secure posterior-anterior coaptation, and because of the considerable bulk of the sutures, particularly that of the loops standing between the posterior surface of the sternum and the pericardium. Another alternative is to drill holes into the sternum and to thread the sutures into those holes. Such drilling leads to greater traumatization and hemorrhaging of the sternum tissue. Moreover, since the drilled tissue will bleed, and since the sutures are passed from the hidden interior surface of the sternum to the anterior surface, it is difficult to locate the holes for threading the sutures therein.
The problem is to provide means for conveniently and reliably inserting the sutures in the preferred way, penetrating the body of the sternum approximately midway between the surgical midline and the lateral margin of the sternum. The need for a device to facilitate this procedure has been strongly felt by the renowned surgeons in the principal cardiac surgery centers of the U.S., and it was in response to their request that I sought for a solution to the problem and made the invention disclosed herein.